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Description of quarters occupied by the employee

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9. Description of quarters occupied by the employee

Date quarters occupied: ________/_________/_______(mm/dd/yy) Type of quarters: House [_____] Apartment [_____] Furnished [_____] Unfurnished [______] Privately Leased [______] Government owned or leased [_____] Personally Owned [_____]	Quarters size: (Total rooms should include dining room, living room, kitchen, bedrooms, den, and bathrooms) Total rooms __________ Total useable square footage_____________ or square meters_____________
10. If employee shares quarters, give name of person(s) with whom sharing and employing firm or agency
11. If employee rents quarters from another U. S. Government employee, give name of that employee and employing agency
12. If employee lets or sublets portion of his owned or leased quarters: (a) Name of sublessee and employing agency or firm_______________________________________________________________ (b) Amount received from sublessee_____________________________ (c) Has amount received from sublessee been deducted from expenses claimed under block 16? _______________ (d) Date let or sublet ______________________________

DSSR Section 960 - Worksheets (TL:SR 711 7/5/09) LQA - page 1 of 2

LQA - Living Quarters Allowance Annual/Interim Expenditures Worksheet (DSSR 130)

13. Employee name (Last, First, Middle initial)	14. Check one: [_____] Estimated or [_____] Actual. LQA expenses for the period from __________________to __________________.
15. FOR OFFICIAL USE ONLY Foreign currency rate used to compute expenses listed under item 16: _____________________. For Personally Owned Quarters (POQ): date of original purchase _______________________; exchange rate at time of original purchase _____________________; and number of years already claimed for rent portion of LQA _____________________.

16. The following expenses were actually incurred or are estimated for the period claimed in block 14. Expenses should be supported by lease or rental agreement, receipts or canceled checks. If unobtainable, explain why under block 17, Remarks.	(A) Foreign Currency Expenses	(B) U.S. Dollar Expenses	(C) For official use only	(D) For official use only
Items (a) through (j) are rent and rent-related expenses
(a) Rent, if leased; or 10% of original purchase price, if owned (claim limit: 10 years)
(b) Garage rental (not to exceed 25% of maximum LQA rate)
(c) Furniture rental (not to exceed 25% of maximum LQA rate)
(d) Insurance on rented property and/or furnishings required by local law to be paid by lessee
(e) Taxes levied by the local government and required by law or custom to be paid by lessee
(f) Land rent, if required by local law or custom (applies only to POQ)
(g) Agent’s fee if mandatory by law or custom and is condition of obtaining lease.
(h) Apartment/condominium fees (Excluding single family dwelling and POQ)
(i) Interest on a loan from American institution to finance “key money” paid to landlord.
(j) Appreciation fee paid directly to landlord. Must appear on lease or rental agreement.
Items (k) through (o) are utilities and utility related expenses
(k) Heat - gas, fuel
(l) Electricity
(m) Other heat, fuel (Specify)
(n) Water
(o) Garbage and trash disposal
Total expenses claimed for this period:

17. Remarks

18. For official use only (DSSR 135 and 136)

Quarters allowance group: _________ WF (“With Family”) ________ WOF (“Without Family”)
Maximum Annual LQA rate (DSSR 920, column 2, plus 10%, 20% or 30% for additional family members) = _________________________________________
Daily LQA rate = Annual LQA rate divided by number of days in calendar year. Biweekly rate = daily rate times 14. Any other period = daily rate times number of days claimed.

Beg. date claimed: _______________ End date claimed: _______________ Number of days claimed: ______________ LQA this period:___________________

19. Employee Statement: I certify that the amounts claimed above were incurred for the period claimed or are estimated to the best of my knowledge for future costs.
Employee’s signature Date

DSSR Section 960 - Worksheets (TL:SR 711 7/5/09) LQA - page 2 of 2
EQA – Extraordinary Quarters Allowance Worksheet (DSSR 138)

Allowable expenses under the Extraordinary Quarters Allowance are calculated here to process a claim on the SF-1190. This worksheet may be reproduced locally.

An Extraordinary Quarters Allowance (EQA) may be paid when the employee and/or family members must vacate permanent residence quarters and occupy temporary quarters for no more than 90 days due to U.S. Government renovations/repairs or other unhealthy or dangerous conditions. The two portions of the EQA are: (1) a lodging portion for actual expenses up to a maximum and (2) a flat meal amount intended to help defray costs in excess of meals normally consumed in the permanent residence. Agencies may have a policy in place to appropriately reduce the amounts if no cost quarters and/or military/USG dining facilities are available. Agencies may also pay only the meal portion of this allowance when U.S. Government renovations/repairs do not require vacating the permanent residence but kitchen facilities are not accessible/usable.
Employee’s Name: _______________________________________Agency: ______________________
Reason for vacating permanent residence quarters: ___________________________________________
Date permanent residence quarters: Vacated: __________________Reoccupied: ___________________
1. Calculation of the Lodging Portion. This is a maximum based on the post of assignment lodging portion of the per diem rate in effect on the date permanent residence quarters are vacated. The employee may be reimbursed for actual expenses up to this maximum. Receipts are required.
Lodging portion of post of assignment per diem rate on date permanent residence quarters were

vacated: __________________________ (See: DSSR Section 925 Maximum Travel Per Diem Rates)

Number of Percentage of lodging Maximum lodging

occupants x portion allowed = portion allowed

Initial Occupant	1	100%
Family Member 12 & over		75%
Family Member under 12		50%
Maximum daily family lodging rate

2. Calculation of the Meal Portion. This is a flat amount per person/per day intended to help defray costs in excess of meals normally consumed in the permanent residence. Receipts are not required. Post allowance continues while receiving the EQA.
a. On the date the permanent residence quarters were vacated:

Maximum per diem rate for post of assignment (DSSR 925): ______________

Post Allowance (DSSR 920, column 3): ________________________
b. From the table on page 2 of this worksheet, locate the box where the maximum per diem rate and post allowance intersect (two examples below table). This will be the per person/per day meal portion of the EQA.
c. Per person/per day meal amount from table: ___________ x family members ______

= Per family/per day meal amount: ________________

3. A sample worksheet is provided on page 2 for recording EQA expenses.

_________________________________________________________________________________________________

DSSR Section 960 – Worksheets (TL:SR-738, 7/18/2010) EQA – 1 of 2

EQA – Extraordinary Quarters Allowance Worksheet (DSSR 138)

EQA TABLE FOR DETERMINING PER PERSON/PER DAY MEAL PORTION
Per Diem Rate for Post of Assignment (DSSR 925)		Post Allowance (for post of assignment from DSSR 920)
From	To	Zero	5% to 15%	20% to 30%	35% to 50%	60% and Above
$50 or Less		$0	$0	$0	$0	$0
$51	$100	$1	$0	$0	$0	$0
$101	$150	$6	$5	$4	$3	$1
$151	$200	$11	$10	$9	$8	$6
$201	$250	$17	$16	$15	$14	$12
$251	$300	$22	$21	$20	$19	$17
$301	$350	$27	$26	$25	$24	$22
$351	$400	$32	$31	$30	$29	$27
$401	$450	$37	$36	$35	$34	$32
$451	$500	$43	$42	$41	$40	$38
$501	$550	$48	$47	$46	$45	$43
$551	$600	$53	$52	$51	$50	$48
$601 & Above		$58	$57	$56	$55	$53

Example 1: If the maximum per diem for the foreign post of assignment is $210 and the

post allowance is 35% then the per person/per day meal amount is $14.
Example 2: If the maximum per diem for the foreign post of assignment is $135 and the

post allowance is zero then the per person/per day meal amount is $6.

SAMPLE WORKSHEET FOR EXTRAORDINARY QUARTERS ALLOWANCE CLAIM

Date	(A) Actual Daily Lodging Amount	(B) Maximum Daily Family Lodging Rate	(C) Maximum Daily Lodging Allowable (lesser of A or B)	(D) Per family/ per day meal amount	(E) Maximum daily EQA (C + D)














Total allowable expenses claimed

_______________________________________________________________________________________________

DSSR Section 960 – Worksheets (TL:SR-738, 7/18/2010) EQA 2 of 2

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